Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Cancer Care > 6. Lung Cancer > Flashcards

6. Lung Cancer Flashcards

1
Q

What are the 3 most common cancers in order?

A

Breast
Prostate
Lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the biggest cause of lung cancer?

A

Smoking, 80%

Radon gas exposure also causes a small % of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the thoracic anatomy

A

Trachea
Splits into left and right main bronchi

Bronchi then split into lobar bronchi
Segmental bronchi
Bronchioles
Alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many lobes does each lung have?

A

Right - 3 lobes
Left - 2 lobes

Not enough space on left for 3 lobes due to heart

Both have oblique fissure
Right also has horizontal fissure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the membrane called that surrounds the lungs?

A

Visceral pleura

Parietal pleura is the chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is the pleural cavity?

A

Potential space between the visceral and parietal pleura

Negative pressure pulls the pleural layers close together

As the chest expands, negative pressure in the pleural cavity pulls the lungs towards the chest wall causing them to expand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does a pleural effusion do to the pleural pressures?

A

Inward pressure on the lungs, reducing lung volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is lung cancer broadly divided?

A

Small cell lung cancer (20%)
Non-small cell lung cancer (80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is non-small cell lung cancer divided?

A

Adenocarcinoma (40%)
Squamous cell carcinoma (20%)
Large cell carcinoma (10%)
Other types (10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of lung cancer is most common in non-smokers?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of cancer is most common in smokers?

A

Squamous cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where do squamous cell carcinomas and adenocarcinomas develop in the lung?

A

Squamous
Develop centrally from epithelial cells lining airways
Take longer to metastasise
Cavitating lesions

Adenocarcinomas
Develop from peripheral mucous secreting cells
Bronchial or alveolar wall
More common in women than men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are squamous cell cancers more likely to do?

A

Lobar collapse or infection due to blockage of airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do large cell carcinomas develop?

A

Throughout the lung
Undifferentiated structure
Centrally or peripherally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do Small cell cancers arise from?

A

APUD cells
Central carcinomas
Fast growing and metastasise early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do small cell lung cancers cause paraneoplastic syndromes?

A

They contain neurosecretory granules which can release neuroendocrine hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 5 paraneoplastic syndromes asscoiated with lung cancer?

A

Small cell
SIADH
- Ectopic ADH secretion so hyponatraemia

Cushing’s Syndrome
- Ectopic ACTH secretion so more glucocorticoids made

Lambert Eaton Syndrome
- Antibodies to voltage gated calcium channels
- Similar to myasthenia gravis

Squamous cell carcinoma
Hypercalcaemia
- Stones, bones, groans
- Due to bony metastases and secretion of PTHrP and calcitriol

Hypertrophic osteoarthropathy
- Clubbing and periostitis
- Symmetrical, painful arthropathy affecting the distal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens to PTH in hypercalcaemia related to SCC?

A

Low PTH

Due to negative feedback from hypercalcaemia, raised PTHrP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some differential diagnoses for symptoms of lung cancer?

A

Pneumonia
Pulmonary TB
PE
Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a mesothelioma?

A

Lung malignancy affecting mesothelial cells of the pleura

Strongly linked to asbestos

Latent period of up to 45 years

Poor prognosis, chemotherapy can improve survival but mainly palliative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does lung cancer present?

A

SOB
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy- supraclavicular nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What causes haemoptysis and coughing in lung cancer?

A

Unstable tumours cause blood vessels to break and bleed

Tumour irritates airways activating cough reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What type of wheeze is heard in lung cancer?

A

Monophonic wheeze
Tumour causes narrowing of single airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What extrapulmonary manifestation is indicated by a hoarse voice?

A

Recurrent laryngeal nerve palsy

Tumour presses on the recurrent laryngeal nerve as it passes through the mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What causes a phrenic nerve palsy in lung cancer?

A

Nerve compression by tumour

Causes diaphragm weakness and SOB

26
Q

What happens in a SVC obstruction?

A

Direct compression of the tumour on the SVC

Facial swelling
Difficulty breathing
Distended neck veins and upper chest veins

27
Q

What is Pemberton’s sign?

A

Raising hands over head causes facial congestion and cyanosis

This is because there is increased obstruction to SVC drainage due to mass pushing against the SVC

28
Q

What causes Horner’s syndrome?

A

Pancoast tumour (adenocarcinomas)

Ptosis
Anhidrosis
Miosis

Tumour presses on the sympathetic ganglion

29
Q

What causes SIADH?

A

Ectopic ADH secreted by small cell lung cancer

Hyponatraemia

30
Q

What causes Cushing’s syndrome in lung cancer?

A

Ectopic ACTH by small cell lung cancer

31
Q

What causes hypercalcaemia in lung cancer?

A

Ectopic PTH by squamous cell carcinoma

32
Q

What is limbic encephalitis?

A

Paraneoplastic syndrome

Small cell lung cancer causes immune system to make antibodies which attack the limbic system in the brain

Leads to :
- Short term memory loss
- Hallucinations
- Confusion
- Seizures

anti-Hu antibodies

33
Q

What happens in Lambert-Eaton myasthenic syndrome?

A

Antibodies produced by immune system against small cell lung cancer

Antibodies also target and damage voltage-gated calcium channels on presynaptic terminals in motor neurones

Weakness in proximal muscles, intraocular muscles and pharyngeal muscles
- Diplopia
- Ptosis
- Slurred speech
- Dysphagia
- Proximal muscle weakness

Other symptoms
- Dry mouth
- Blurred vision
- Impotence
- Dizziness

34
Q

What is the referral criteria for lung cancer?

A

CXR within 2 weeks to patients over 40 with :
- Clubbing
- Lymphadenopathy (supraclavicular)
- Recurrent or persistent chest infections
- Thrombocytosis
- Chest signs of lung cancer

35
Q

When should patients also be given a CXR?

A

Over 40 with :
- Two or more unexplained symptoms that have never smoked
- One or more unexplained symptoms that have smoked

36
Q

What are unexplained symptoms in relation to lung cancer?

A

Cough
SOB
Fatigue
Chest pain
Weight loss
Loss of appetite

37
Q

What is the first line investigation in suspected lung cancer?

A

Chest x-ray
Hilar enlargement
Peripheral opacity (visible lesion in lung field)
Pleural effusion (unilateral usually)
Diaphragm collapse or lung collapse

FBC and CRP - exclude infectious causes
U&Es and bone profile

38
Q

How does lobar collapse present on CXR?

A
  • Tracheal deviation towards side of collapse
  • Mediastinal shift towards side of collapse
  • Elevation of the hemidiaphragm
39
Q

What other investigations can be used in confirmed lung cancer?

A

CT CAP with contrast
- Assess TNM status
- Using contrast gives more information about different tissues

PET-CT
- Radioactive tracer, images taken with a CT scanner and gamma-ray detector
- Useful to see if cancer has spread by showing increased metabolic activity

Bronchoscopy with endobronchial USS (EBUS)
- Endoscopy with USS on scope
- Allows details tumour assessment and USS guided biopsy

Histological diagnosis
- Biopsy to check type of cells in tumour
- By bronchoscopy or percutaneous biopsy

40
Q

How is lung cancer treated?

A

MDT meeting

Surgery
First-line in non-small cell lung cancer
Disease isolated in single area
Entire tumour removed

Radiotherapy
Can be curative in non-small cell lung cancer when diagnosed early

Chemotherapy
Can be offered in addition to surgery or radiotherapy in certain patients to improve outcomes
Or palliative to imrpove survival and QoL in later stages of non-small cell lung cancer

Endobronchial stenting or debulking
Can be used as part of palliative to relieve bronchial obstruction from lung cancer

41
Q

How is small cell lung cancer treated?

A

Chemotherapy and radiotherapy

Prognosis is worse than non-small cell

42
Q

What gene mutations present in lung cancer are favourable for treatment?

A

EGFR-TK
ALK
ROS-1

On T-Cells

PD-L1 at 50% or above if no above mutations

43
Q

What is Systemic anti-cancer therapy (SACT) used in non-squamous NSCLC?

A

If these mutations are present checkpoint inhibitors are used

Epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation:
Afatinib, erlotinib and gefitinib

Anaplastic lymphoma kinase-positive (ALK) gene rearrangement:
Crizotinib, ceritinib and alectinibs

44
Q

If NSCLC has no gene mutations so cannot have systemic anti cancer therapy, what chemotherapy are they offered instead?

A

Usually platinum based

45
Q

What is the prognosis in lung cancer?

A

One year survival - 40%

Five year survival - 15%

46
Q

What is the prognosis of small cell lung cancer?

A

1-3 months if untreated

15 months with chemotherapy

47
Q

What is done prophylactically in SCLC?

A

Prophylactic cranial radiotherapy as 50% develop brain mets

48
Q

How is small cell lung cancer staged?

A

VALSG staging

Limited disease: tumour not spread beyond hemithorax, regional nodes that may be treated with single radiotherapy field

Extensive disease: tumour spread beyond hemithorax or extensively through the hemithorax, distant metastasis, malignant effusions or contralateral hilar/supraclavicular involvement

TNM used for NSCLC

49
Q

When is lung cancer surgery contraindicated?

A

Stage IIIb or IV
FEV < 1.5
Malignant pleural effusion
Tumour near hilum
SVCO

50
Q

What options are there for removing a lung tumour?

A

Segmentectomy or wedge resection

Lobectomy
Entire lobe containing tumour removed (most common)

Pneumonectomy
Removing entire lung

Sleeve resection
Removing one lobe and part of the bronchi

51
Q

What are the different types of surgery for lung cancer?

A

Thoracotomy
Open surgery, incision and separation of rib to access thoracic cavity

Video-assisted thorascopic surgery (VATS)
Keyhole surgery

Robotic surgery

52
Q

What type of surgery is preferred in lung cancer?

A

Minimally invasive e.g. VATS or robotic

Faster recovery and fewer complications

53
Q

What are the main thoracotomy incisions?

A

Anterolateral thoractomy
Incision around front and side

Axillary thoracotomy

Posterolateral thoracotomy
Incision around back and side (most common)

54
Q

What is the done differently between thorascopic surgery and laparosopic?

A

Thorascopic is done by deflating the lung

Laparoscopic the abdomen is inflated

55
Q

What indicates a pneumonectomy vs lobectomy on examination?

A

If there is a thoracotomy scar and there is no breath sound on that side

Indicates entire lung removal rather than lobectomy

If absent lung sounds in a specific area, indicates a lobectomy

56
Q

Why is a chest drain left in after thoracic surgery?

A

Allows air and fluid to leave the thoracic cavity and lungs to expand

Chest drain pump can be used to suck fluid and air out of chest

57
Q

How does a chest drain work?

A

External end placed underwater

Creates a seal to prevent air going back through drain into chest

Air can still exit chest and bubble through water, but water prevents air re-entering

Water in drain will rise and fall due to changes in chest pressure - swinging

58
Q

What are the symptoms of pneumonitis?

A
  • Shortness of breath
  • Low sats
  • Fever
  • Cough
  • Chest pain with breathing

Do CXR, Chest CT, Lung function tests and bloods/sputum to rule out infection

59
Q

How is radiation pneumonitis treated?

A

Prednisolone long-term
Oxygen therapy
NSAIDs
Bronchodilators

Treat the same as pulmonary fibrosis

60
Q

Before thoracic surgery what should be done in all patients?

A

Peak flow and spirometry

Calculate predicted post-operative respiratory capacity to guide the type or resection

Pneumonectomy - 50% reduction in FEV1
Lobectomy - 20% reduction

Therefore >1L in lobectomy
>2L in pneumonectomy

Y4 Cancer Care (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions